nicotene TN AES SN arta itt
senate indepnanp egress hoped NAA ce LPAI AAO IEG Cs Pas SaRS aCe ACA ENR es 2
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se a A aA NS NN Ab AI PC ACT SR NRO QB in mE NNN
pA CORAM PRD EEN
Onyalai—
continued
140 REVIEW—TROPICAL MEDICINE, ETC.
more tropical and humid regions of the Sudan, such as the Bahr-El-Ghazal Province, it is perhaps well to direct attention to it, the more so that Feldman has seen a somewhat similar disease in Hast Africa called ‘‘ Kdjuo,” and Mense, on the Congo, met with a condition exhibiting some of the symptoms of ‘ Onyalai’’ and termed ‘‘ Kafindo”’ by the Unyamwezi people.
The etiology is quite obscure. Wellman seems to have proved that it has nothing to do with malaria, trypanosomiasis, Schonlein’s disease, Henoch’s purpura, Purpura hamorrhagica, accidental or intentional poisoning or snake bite, though it may resemble the effects produced by the bite of the puff-adder (Olotho arietans, Gray).
Wellman, indeed, considers the disease to be a specific entity, an acute infectious disease, the cause of which is as yet undetermined.
The account given of the clinical features is here reproduced :—
Most of my cases were attacked suddenly. Lassitude and a sort of dazed appearance was generally marked. In some cases the parotid glands were tender to the touch. The eyes appeared heavy and sometimes reddened. In most instances the tongue was swollen and painful. A slight temperature was noted in about a third of the cases. I have had patients complain of numbness and of pain in various parts of the body. One man who had bloody diarrhoea suffered much from colicky pains. The appetite is usually poor. The bull may appear in the mouth, pharynx, cesophagus, stomach and bowels. Vomiting of blood is not rare. The skin also usually shows lesions. The genito-urinary system was affected in three of my cases. Hematuria was a prominent symptom in all of these. When the process occurs in the cranial cavity various symptoms of profound central disturbance are set up. Three cases of this kind have come to my attention. One of these was a young woman in rude health. She was laughing and playing on the evening of her attack. Suddenly she complained of being tired, and in an hour or so bull appeared in her mouth. She steadily grew more depressed, and died about eight o’clock the next morning, with all the symptoms of cerebral hemorrhage, z.¢c. loss of consciousness, inactive, dilated pupils, slow, noisy, stertorous breathing, etc. The pulse was very slow and increased in tension. Another fatal case in the same house, a strong young man being the victim, presented almost exactly the same symptoms. A third fatal case showed no vesicles, either in the mouth or in the skin. The feces and urine likewise contained no blood. Another case which I have also referred to this disease likewise showed no vesicles, but died from the effect of what I believe to be the same process in the liver, spleen and pancreas. (These last two cases were shown microscopically not to be pernicious malaria.) The superficial bulle, when present, are characteristic. They range from the size of a split pea to several inches in diameter. The larger ones are irregular in outline, and are often umbilicated. They are deep, and involve the corium or submucous structure. There seems to take place an extensive histolysis, only the fibrous elements persisting. These appear as trabecule, the interstices of which are filled with partially coagulated and otherwise altered blood which shows dark under the skin or mucous membrane. The red corpuscles, however, are not all disintegrated, and may be seen under the microscope in the oozing from the blebs, and also in the feces, urine, saliva, etc., according to the situation of the lesions.. In one or two cases the bullz were very small, and not numerous, and had the patients not directed attention to them would probably have been overlooked.
The Congo disease described by Mense! is characterised by depression, malaise, headache, reddened conjunctive, numbness, swelling of the tongue, loss of appetite and occasional bloody diarrhwa, dyspnea, cardiac disturbances, etc., all of which have been noted in ‘‘ Onyalai.” Bulle, however, were not observed. The prognosis of ‘‘Onyalai’’ is still an unknown quantity. The malignancy of the disease appears to vary greatly. Natives often regard it as very fatal. No treatment seems of much use, except possibly arsenic in large doses.
Information is desired regarding the possible occurrence of this interesting condition within the confines of the Sudan. & Oriental Sore. So far as one can find out, this condition does not exist in the Sudan. Colonel Hunter, P.M.O., tells me he has never seen it. At the same time, it is one of much interest, and as it is associated with the presence of parasites identical with
the Leishman-Donovan body, and as kala-azar occurs in this country, it is necessary to consider recent work upon it.
In a recent important discussion on the subject, Manson? points out that the disease has the peculiarity of being protective against itself. He also alludes to the difficulty in stating the duration of the incubation period, which is sometimes short, but frequently runs into months. Nearly always an exposed part of the body is affected, and Manson suggests that the disease is inserted by some animal which attacks these parts. The bug, flea and similar insects are therefore excluded. The mosquito and various flies would, however, probably be effective carriers. The disease is inoculable, but inoculation experiments may fail possibly because the parasites have disappeared from the sore or are in an unhealthy condition or have undergone involution.
1 Mense, C. (1906), Handbuch der Tropenkrankheiten, p. 789, Vol. IIT.
2 Manson, Sir P. (December 2nd, 1907), ‘Demonstration of Oriental Sore and its Parasite.” Journal of Tropical Medicine and Hygiene, Vol. X.